What is the treatment for angular cheilitis?

Angular Cheilitis Treatment

First-line treatment for angular cheilitis is combination therapy with a topical antifungal and corticosteroid, which simultaneously addresses the fungal infection (primarily Candida) and reduces inflammation. 1, 2

Treatment Algorithm

Initial Management: Combination Therapy

• Apply topical antifungal-corticosteroid combination (such as 1% isoconazole nitrate with 0.1% diflucortolone valerate) to affected corners of the mouth 3
• The antifungal component targets Candida albicans, the most common fungal pathogen 1, 2
• The corticosteroid component reduces inflammation and discomfort 1
• This combination provides the broadest coverage against dermatophytes and bacteria while managing inflammation 3

Alternative Topical Treatments (if combination therapy unavailable or contraindicated)

For primarily fungal infection:

• Nystatin oral suspension: 100,000 units four times daily for 1 week 1, 2
• Miconazole oral gel: 5-10 mL held in mouth after food four times daily for 1 week 1, 2
• Fluconazole: 100 mg/day for 7-14 days for resistant cases 1, 2

For primarily bacterial infection:

• Antiseptic oral rinse containing chlorhexidine twice daily 1

Essential Supportive Measures

• Apply white soft paraffin ointment to lips every 2-4 hours as an emollient 1
• Warm saline mouthwashes daily for oral hygiene 1
• Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, for anti-inflammatory effect 1

Critical caveat: Avoid chronic use of petroleum-based products on lips—they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk 1

Addressing Underlying Causes

Mechanical factors to correct:

• Evaluate and correct ill-fitting dentures 1
• Consider occlusal vertical dimension restoration if loss of vertical dimension is present 1
• Address habits like lip licking or mouth breathing 1

Systemic factors to evaluate:

• Screen for diabetes or immunosuppression 1
• Check for nutritional deficiencies, particularly riboflavin and iron 2, 4
• Review medications that may contribute to the condition 1

Follow-Up and Reassessment

• If no improvement after 2 weeks: Reevaluate for correct diagnosis and assess patient compliance 1, 2
• Consider alternative diagnoses if treatment fails 1

Special Populations

Immunocompromised patients:

• Require more aggressive and prolonged therapy 1, 2
• Monitor closely for treatment failure or recurrence 1

Important distinction: Angular cheilitis differs from actinic cheilitis, which is a premalignant sun-related condition requiring different treatment approaches (photodynamic therapy, 5-fluorouracil, cryosurgery, or laser vermilionectomy) 5, 1